Accurate BP measurement and subsequent management is contingent on strict BP measurement techniques . The Canadian Hypertension Education Program (CHEP) guideline has released one such protocol to standardize BP measurement. . Variations of 40mmHg or more has been observed with the variation of BP measurement technique . 
Objective:
This project serves to determine the effects of a systematic and interdisciplinary collaborative approach to implement the CHEP BP measurement protocol in a stroke rehabilitation ward. 
Methods:
Measurement of change:
The usual practice of BP measurement was observed by trained researchers (baseline measurement).
Barriers to BP measurement was addressed. Optional session by a nurse educator on BP measurement protocol. Hard copy of the BP measurement protocol was distributed in the staff room for convenient access. New sets of BP cuffs were purchased. One nurse during each day shift was moved earlier by 30 minutes.
The same third party observed the nurses during morning BP measurements after the barriers has been addressed.
Statistical analysis was performed by a statistician utilizing a repeated measures methodology.
Results:
The criterion, no exercise prior to BP measurement, had a statistically significant improvement (p=0.02). (see table 1)
The balancing measure, total time spent on each BP measurements trended towards less time in the post versus the baseline. This trend is present even after accounting for outliers.
By changing 1 nurse’s day shift schedule, patient’s BP were measured in their rooms rather than in a common area. Therefore, time for each BP measurement was assessed as a balancing measure . Subjectively, data collectors noted fewer overall distractions while patients were still in their rooms. 
Conclusion:
We demonstrated a multi-faceted, collaborative, interdisciplinary approach to improve adherence to the CHEP BP protocol. In general, institutional effects had the least adherence at baseline and improved the most. Improvement in ensuring no physical activity prior to BP measurement reached statistical significance. These changes did not negatively affect the workflow of nurses

ADDRESSING THE BARRIERS PREVENTING GUIDELINE ADHERENCE FOR BLOOD PRESSURE MEASUREMENT ON AN INPATIENT STROKE REHABILITATION WARD.